Abstract
We want to thank Dr J. Alexander de Ru for his letter to the editor. We agree with his distinction between AOM and OME and do not find the content of the supplement to contend that the 2 entities are one in the same. The concept of OME as a “firewall that is set up by the middle ear in order to prevent the possible fatal complications of AOM” is not widely held by experts in middle ear disease and appears to be a hypothesis of Dr de RU which is unsupported. The literature is replete with medical therapies that by and large either fail to cure OME or, as the case with systemic steroids, may hold a very small treatment advantage over spontaneous resolution alone that does not offset the potential adverse effects of systemic steroids. We agree with Dr de RU that OME will spontaneously resolve in several cases but disagree that except in “exceptional cases” tympanostomy tube are not appropriate treatment for select cases where evidence-based guidelines support their use. Lastly, though perhaps a matter of semantics, we would disagree with Dr de Ru’s contention that “research, time, and money” expended on OME is wasted by “improper…studying of a disease that is not a disease after all.” The accepted definition of a disease is “a particular abnormal condition that negatively affects the structure or function.” There is no debate that OME is an abnormal condition and that negative effects on both structure and function result. Given the common occurrence of this condition in children, having research that produces “evidence” to guide our treatment is invaluable and irreplaceable. Practicing evidence-based medicine is important in today’s health care environment because this model of care offers clinicians a way to achieve the Triple Aim’s objectives of improved quality, improved patient satisfaction, and reduced costs. To disparage research that produces evidence basis for medical decision-making is setting medicine back over 3 decades to a period of anecdotal medical practice, dependent on the habits of individual senior physicians or the marketing efforts of pharmaceutical companies and with more costly, inconsistent, and poor outcomes.
